Abstract 4371207: Impairments in Sleep and Physical Activity Are Comparable in CMD and Obstructive CAD and Independently Predict Angina Burden

Background: The impact of sleep quality and physical activity in coronary microvascular dysfunction (CMD) remains unclear [1, 2] with prior studies relying on self-reported measures [3, 4, 5]. We evaluated whether objective actigraphy-based sleep and activity measures are related to angina symptoms in CMD compared to those with a history of obstructive coronary artery disease (oCAD) and healthy controls. Methods: We analyzed Actiwatch and Seattle Angina Questionnaire (SAQ) data from post-menopausal women enrolled in the ongoing mental stress in coronary microvascular dysfunction (MS-CMD) study with ≥7 days of recordings. CMD was defined by CFR < 2.5 or PET MFR ≤ 2.5; oCAD as history of ≥70% stenosis requiring revascularization. Healthy reference group consisted of asymptomatic post-menopausal women who passed an exercise treadmill test. Activity and sleep metrics were extracted and SAQ subdomains scored, including quality of life (QoL). Missing data were imputed using bootstrap-based KNN with pooled estimates. We used standard statistical tests for inter-group and in-group comparisons. Significant findings we adjusted through regression models. Results: Data from 55 women (13 CMD, 15 oCAD, 27 controls; age 62.0 ± 9.4 y; BMI 27.3 +/- 4.5 kg/m2) were analyzed. Groups were similar in most comorbidities (Table 1). Controls had higher steps, METs, and active minutes than CMD and oCAD (Figure 1). Sleep metrics did not differ across groups. After adjusting for confounders, in CMD, awakening duration positively predicted angina frequency (p<0.001), sleep hours negatively predicted QoL (p = 0.004), and both METs (p = 0.005) and moderate minutes (p<0.001) were negative predictors of treatment satisfaction (Table 2). In oCAD, hourly kcals (p = 0.023), total active minutes (p = 0.018) and moderate minutes (p = 0.050) positively predicted treatment satisfaction. Conclusions: Post-menopausal women with CMD exhibit sleep fragmentation and reduced physical activity on par with oCAD, and these behavioral domains are linked to greater angina burden. These findings highlight sleep hygiene and symptom-tailored activity interventions as promising, modifiable strategies to alleviate angina.